Clinical impact of percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy in patients with moderate to severe acute cholecystitis: A propensity score-matched case-control study.

Percutaneous transhepatic gallbladder drainage (PTGBD) is frequently performed for moderate to severe acute cholecystitis (AC) when early laparoscopic cholecystectomy (LC) is not feasible. While PTGBD relieves symptoms, its impact on surgical outcomes is uncertain. We retrospectively analyzed 505 patients with grade II or III AC undergoing LC (2012-2022). After propensity score matching, 122 received PTGBD and 122 underwent direct LC. PTGBD was associated with longer time to surgery (10.1 vs. 3.6 days), higher ICU admission (44.3 ​% vs. 22.1 ​%), and prolonged hospital stay (18.2 vs. 11.3 days), without reducing postoperative complications. Importantly, delayed hospital presentation (>4 days from symptom onset) independently increased postoperative complications (OR:3.01, 95 ​% CI:1.16-7.81, P ​= ​0.023). Early LC yielded shorter hospital and ICU stays compared with delayed surgery. These findings indicate that PTGBD may extend hospitalization and ICU use without improving outcomes, underscoring the importance of timely admission and early LC in moderate to severe AC.